Types of Health Insurance Plans

Within the healthcare umbrella for insurance plans accessible to you, there are nine options available for you to utilize, each offering different benefits based upon your needs. We know, it can be daunting trying to figure out exactly which one to use. However, if receiving therapeutic care is new to you, figuring out what insurance plan works for you is an important part of the process. We recommend you look over the below options before and during your first session to affirm clarity on which method you will be paying to your provider. 

• Health Maintenance Organizations (HMO)
• • Set monthly fee (premium) with little to no deductible
  • Providers lower their prices for people in-network and insured by their organization
  • DO NOT cover out-of-network service unless it is an emergency
  • May have to live in the service area of the HMO for eligibility
  • May have to select a Primary Care Physician (PCP) who offers basic healthcare and specialty care on occasion

• Preferred Provider Organization (PPO)
• • Includes in-network providers but also covers out-of-network providers
  • Higher monthly premium with deductible
  • More benefits for in-network providers
  • Does not require the assistance of a PCP for referral to a specialist

• Exclusive Provider Organization (EPO)
• • Only allowed to use the provided network of providers
  • Does not cover out-of-network providers
  • Do not need a referral from a PCP to seek specialist services

• Point-of-Service (POS)
• • Set monthly fee (premium) with little to no deductible
  • Providers lower their prices for people in-network and insured by their organization
  • Can use an out-of-network provider under certain circumstances for a higher fee
  • Requires a referral from a PCP for all specialty care

• Medicaid Managed Care
• • Arrangement between Medicaid and Managed Care Organizations (MCOs) to cover Medicaid-covered services for enrollees
  • Recipients may be enrolled in private healthcare plans where state pays a fixed monthly premium
  • Differing private insurance companies offer different benefits, which recipient can speak with to access

• High-deductible Health Plan (HDHP) / Health Savings Account (HSA)
• • HDHPs require higher deductibles and lower premiums
  • First pay out of pocket, and insurance company covers the rest
  • HSA allows pre-tax money to be put in a savings account for health costs not covered by insurance (coinsurance, copays, dental care, etc.)
  • People with employer-based health insurance can combine HDHP and HSA

• Indemnity Health Insurance Plans (fee-for-service plan)
• • Able to see any specialist 
  • Pay an upfront out-of-pocket fee, then file a claim to be reimbursed by insurance
  • Responsible for deductibles and coinsurance costs

• Fee for service
• • Services unbundled and paid for separately
  • Payments issued after each service provided 
  • When provided outside of your PPO, health plans will pay the medical provider directly or reimburse you after filing claims 

• Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)
• • For small businesses with fewer than 50 employees
  • Offers employees monthly allowance of tax free money
  • Able to choose and pay for which healthcare services they want
  • Employees file for reimbursement, which business will do up to the allowance amount

That was a lot! Even though this process seems very difficult, you may also speak with your provider about which payment method would be best for you during your first session. We are here to help, so don’t be afraid to ask questions!

For more assistance, please feel free to reach out to our Support Team at support@miresource.com.

.

Updated on: 07/10/2025